Eligibility & Enrollment

Eligibility and Enrollment staff (E&E) enroll consumers in the State Benefit Plan through Provider Enrollment Request; update member information through Provider Update Requests; process discharges for state members; and verify Medicaid, State and COB coverage for providers and other Vaya Health departments. E&E staff also verify, add and update Medicaid C eligibility in AlphaMCS.

The Eligibility and Enrollment Team can answer the following questions:

How do I enroll a consumer into state mental health services? (enrollments)

How do I update information in a consumer’s record? (consumer updates)

Why can’t I pull up a consumer in Alpha?

What is an explanation of Medicaid’s categories of eligibility?

How can I get a Common Name Data Service (CNDS) number for a consumer? (This includes looking it up in Alpha or creating one in NCTracks.)

How can I activate Medicaid C insurance layer for the month in Alpha?

How can I verify if Medicaid B is active?

How can I verify if State insurance is active?

What if I have questions about the claim denial “no coverage on date of service”?

Why does an individual see something different in NCTracks from what we have in Alpha? (GEF)

What if I have questions about 3rd party insurance and dual eligibility

Medicaid Categories of Aid and the 1915(b)(c) Waiver

Although Vaya is responsible for the administration of Medicaid waivers, we are not responsible for all Medicaid categories of aid. Review the information below to learn more about covered populations and Medicaid categories of aid for which Vaya is responsible as a payer under the 1915(b)(c) Waiver.

The eligibility status of Medicaid recipients who qualify for a category of aid covered by the waiver is downloaded into AlphaMCS through the Global Eligibility File (GEF), which is generated by NCTracks and updated daily.

The following Medicaid populations remain “Fee for Service” and are not covered by MCOs under the 1915 (b)(c) waivers:

Infants under age 3, except those who are eligible for Innovations

Qualified Medicare beneficiaries

Specified low-income beneficiaries

Children enrolled in the N.C. Health Choice (NCHC) Health Insurance Program for Children

Legal and Illegal aliens

Refugees

Individuals eligible for the Program of All-Inclusive Care for the Elderly